Adverse pregnancy outcomes attributable to socioeconomic and ethnic inequalities in England: a national cohort study (1 November 2021)

Summary

This nationwide study of over 1 million births in the English NHS between 2015 and 2017, published in The Lancet, has found large inequalities in pregnancy outcomes between ethnic and socioeconomic groups in England.

The findings from Jardine et al. suggest that current national programmes to make pregnancy safer, which focus on individual women's risk and behaviour and their antenatal care, will not be enough to improve outcomes for babies born in England. The authors say that to reduce disparities in birth outcomes at a national level, politicians, public health professionals, and healthcare providers must work together to address racism and discrimination and improve women's social circumstances, social support, and health throughout their lives.

Content

Key findings

• Nationwide study of more than 1 million pregnancies in England finds that socioeconomic inequalities account for a quarter of stillbirths, a fifth of preterm births, and a third of births with fetal growth restriction—a condition in which babies are smaller than expected for their gestational age.
• South Asian and Black women living in the most deprived areas experience the largest inequalities in pregnancy outcomes.
• Estimates suggest that half of stillbirths and three-quarters of births with fetal growth restriction in South Asian women living in the most deprived 20% of neighbourhoods are potentially avoidable if this population had the same risks as white women living in the most affluent 20% of neighbourhoods.
• Similarly, about two-thirds of stillbirths and about half of births with fetal growth restriction in Black women from the most deprived neighbourhoods are potentially avoidable if they had the same risks as white women from the most affluent neighbourhoods.
• The authors call for concerted action by maternity services as well as public health professionals and politicians to protect women and their babies through a combination of population approaches and targeting high-risk groups, addressing both wider determinants of health (eg, poverty and structural racism) and specific risk factors (eg, maternal smoking).